DONOR PREFERENCE SURVEY

Question Title

* 1. Please provide your contact information.

Name:

Mailing Address:

City:

State:

Zip:

Occupation:

Employer:

Question Title

* 2. Birth date MM/DD/YYYY:

Question Title

* 3. Best number to each you at:

Please provide number with area code:

Question Title

* 4. My employer has a matching gift program.

Yes

Question Title

* 5. Are you a Thrivent Choice participant?

Yes

Question Title

* 6. Would you like to receive Samaritan's monthly eNewsletter, as well as other information and invitations via email?

Yes

Question Title

* 7. If you answered 'yes,' please provide your email address:

Question Title

* 8. Which events/campaigns/workshops are you interested in? (Check all that apply)

Ethics in Business Summit

Race the Lake

Silent Samaritan Campaign & Thank You Luncheon

Creating Hope Workshop

Faith Leader Mental Health Integration Project Educational Series

Question Title

* 9. How did you come to be a donor at Samaritan Counseling Center? (Check all that apply)

Self or family member received services

Attended event, workshop, etc.

Mental health is important to me

I was/am a volunteer or board member

Other (please specify)

Question Title

* 10. How often would you like to be updated on our activity?:

Monthly

Quarterly

Annually

Question Title

* 11. Please indicate if you agree or disagree:

	Agree	Disagree
I believe my donation to Samaritan is important.	I believe my donation to Samaritan is important. Agree	I believe my donation to Samaritan is important. Disagree
I believe the impact of my donation is clear and measurable.	I believe the impact of my donation is clear and measurable. Agree	I believe the impact of my donation is clear and measurable. Disagree
I believe my donation to Samaritan is managed properly.	I believe my donation to Samaritan is managed properly. Agree	I believe my donation to Samaritan is managed properly. Disagree
I believe mental health should be a top priority in our community.	I believe mental health should be a top priority in our community. Agree	I believe mental health should be a top priority in our community. Disagree

Question Title

* 12. What are the guiding principles you use to make your philanthropic decisions?

Question Title

* 13. To what extent does our mission (vision, work) reflect your personal beliefs?

Very much

Somewhat

Not very much

How so?

Question Title

* 14. What do you expect from the charitable organizations in which you are involved?

Question Title

* 15. To what extent are we meeting those expectations?

Very well

Moderately well

Not very well

How could we enhance that?

Question Title

* 16. Of the charities to which you donate, which ones do the best job sharing the significance and impact of your gifts? How so?

Question Title

* 17. Check all that apply:

I prefer to remain anonymous with my donations.

I would like to invest monthly via ACH transfers. Please have someone contact me.

I would like to speak to someone about planned giving (designating a gift to Samaritan in my will).

I would like to volunteer at Samaritan. Please have someone contact me about opportunities.

I would like to invest in your Capital Campaign. Please have someone contact me about this.

DONOR PREFERENCE SURVEY

Question Title

* 1. Please provide your contact information.

Question Title

* 2. Birth date MM/DD/YYYY:

Question Title

* 3. Best number to each you at:

Question Title

* 4. My employer has a matching gift program.

Question Title

* 5. Are you a Thrivent Choice participant?

Question Title

* 6. Would you like to receive Samaritan's monthly eNewsletter, as well as other information and invitations via email?

Question Title

* 7. If you answered 'yes,' please provide your email address:

Question Title

* 8. Which events/campaigns/workshops are you interested in? (Check all that apply)

Question Title

* 9. How did you come to be a donor at Samaritan Counseling Center? (Check all that apply)

Question Title

* 10. How often would you like to be updated on our activity?:

Question Title

* 11. Please indicate if you agree or disagree:

Question Title

* 12. What are the guiding principles you use to make your philanthropic decisions?

Question Title

* 13. To what extent does our mission (vision, work) reflect your personal beliefs?

Question Title

* 14. What do you expect from the charitable organizations in which you are involved?

Question Title

* 15. To what extent are we meeting those expectations?

Question Title

* 16. Of the charities to which you donate, which ones do the best job sharing the significance and impact of your gifts? How so?

Question Title

* 17. Check all that apply:

Question Title

* 18. What advice would you like to give us?